]]>Mon,13 Nov 2017http://www.ijo.in/text.asp?2017/65/11/1073/218085
How safe is safe, and where are we in the journey toward safest of safe?Lalit DarRadhika TandonGuest EditorialIndian Journal of Ophthalmology 2017 65(11):1075-1076doi:10.4103/ijo.IJO_1054_17Indian Journal of Ophthalmology10.4103/ijo.IJO_1054_17http://www.ijo.in/text.asp?2017/65/11/1075/218035http://www.ijo.in/text.asp?2017/65/11/1075/218035651110751076http://www.ijo.in/text.asp?2017/65/11/1075/218035Lalit Dar, Radhika Tandon

The purpose of the study is to describe epidemiology, clinical features, diagnosis, and treatment of Acanthamoeba keratitis (AK) with special focus on the disease in nonusers of contact lenses (CLs). This study was a perspective based on authors&#39; experience and review of published literature. AK accounts for 2&#37; of microbiology-proven cases of keratitis. Trauma and exposure to contaminated water are the main predisposing factors for the disease. Association with CLs is seen only in small fraction of cases. Contrary to classical description experience in India suggests that out of proportion pain, ring infiltrate, and radial keratoneuritis are seen in less than a third of cases. Majority of cases present with diffuse infiltrate, mimicking herpes simplex or fungal keratitis. The diagnosis can be confirmed by microscopic examination of corneal scraping material and culture on nonnutrient agar with an overlay of Escherichia coli. Confocal microscopy can help diagnosis in patients with deep infiltrate; however, experience with technique and interpretation of images influences its true value. Primary treatment of the infection is biguanides with or without diamidines. Most patients respond to medical treatment. Corticosteroids play an important role in the management and can be used when indicated after due consideration to established protocols. Surgery is rarely needed in patients where definitive management is initiated within 3 weeks of onset of symptoms. Lamellar keratoplasty has been shown to have good outcome in cases needing surgery. Since the clinical features of AK in nonusers of CL are different, it will be important for ophthalmologists to be aware of the scenario wherein to suspect this infection. Medical treatment is successful if the disease is diagnosed early and management is initiated soon.]]>Mon,13 Nov 2017http://www.ijo.in/text.asp?2017/65/11/1079/218084
Mitochondrial genetics and therapeutic overview of Leber&#39;s hereditary optic neuropathyAgaath Hedina ManickamMinu Jenifer MichaelSivasamy RamasamyReview ArticleIndian Journal of Ophthalmology 2017 65(11):1087-1092doi:10.4103/ijo.IJO_358_17Indian Journal of Ophthalmology10.4103/ijo.IJO_358_17http://www.ijo.in/text.asp?2017/65/11/1087/218044http://www.ijo.in/text.asp?2017/65/11/1087/218044651110871092http://www.ijo.in/text.asp?2017/65/11/1087/218044Agaath Hedina Manickam, Minu Jenifer Michael, Sivasamy Ramasamy

Indian Journal of Ophthalmology 2017 65(11):1087-1092

Leber&#39;s hereditary optic neuropathy (LHON) is a common inherited mitochondrial disorder that is characterized by the degeneration of the optic nerves, leading to vision loss. The major mutations in the mitochondrial genes ND1, ND4, and ND6 of LHON subjects are found to increase the oxidative stress experienced by the optic nerve cell, thereby leading to nerve cell damage. Accurate treatments are not available and drugs that are commercially available like Idebenone, EPI-743, and Bendavia with their antioxidant role help in reducing the oxidative stress experienced by the cell thereby preventing the progression of the disease. Genetic counseling plays an effective role in making the family members aware of the inheritance pattern of the disease. Gene therapy is an alternative for curing the disease but is still under study. This review focuses on the role of mitochondrial genes in causing LHON and therapeutics available for treating the disease. A systematic search has been adopted in various databases using the keywords &#8220;LHON,&#8221; &#8220;mitochondria,&#8221; &#8220;ND1,&#8221; &#8220;ND4,&#8221; &#8220;ND6,&#8221; and &#8220;therapy&#8221; and the following review on mitochondrial genetics and therapeutics of LHON has been developed with obtained articles from 1988 to 2017.]]>Mon,13 Nov 2017http://www.ijo.in/text.asp?2017/65/11/1087/218044
Uveal effusion syndrome in 104 eyes: Response to corticosteroids &#8211; The 2017 Axel C. Hansen lectureCarol L ShieldsKelsey RoelofsMaura Di NicolaKareem SioufiArman MashayekhiJerry A ShieldsFeatured Original ArticleIndian Journal of Ophthalmology 2017 65(11):1093-1104doi:10.4103/ijo.IJO_752_17Indian Journal of Ophthalmology10.4103/ijo.IJO_752_17http://www.ijo.in/text.asp?2017/65/11/1093/218081http://www.ijo.in/text.asp?2017/65/11/1093/218081651110931104http://www.ijo.in/text.asp?2017/65/11/1093/218081Carol L Shields, Kelsey Roelofs, Maura Di Nicola, Kareem Sioufi, Arman Mashayekhi, Jerry A Shields

Purpose: Overexpression of the inhibitors of apoptosis proteins have been demonstrated in a variety and of solid tumors including melanomas and nonmelanomas skin cancers. X-linked inhibitor of apoptosis protein (XIAP) is an inhibitor of apoptosis which prevents apoptosis by inhibiting caspases 9, 7, and 3. The prognostic value of XIAP in sebaceous gland carcinoma (SGC) remains unexplored. Methods: The immunohistochemical expression of XIAP was evaluated in 29 SGC cases. Results: The cytoplasmic overexpression of XIAP was detected in 62&#37; SGC cases. XIAP expression was found to be significantly associated with advanced age, large tumor size, and with reduced disease-free survival (P &#61; 0.0174). XIAP expression and advance tumor Grade III emerged as significant risk factors on univariate analysis. On stepwise multivariate analysis, both increased cytoplasmic XIAP expression and high tumor grade were found to be significantly associated with recurrence. Patients with low XIAP immunoexpression had a longer disease-specific survival than those with high expression in the 5-year follow-up. Conclusion: The present study demonstrates at the immunohistochemical level that XIAP is overexpressed in SGC and that high expression could be of biological significance in the development of eyelid SGC. Our finding suggests that up-regulation of XIAP may aggravate tumor metastasis in SGC.]]>Mon,13 Nov 2017http://www.ijo.in/text.asp?2017/65/11/1109/218048
Is the distance from punctum a factor in the anatomical and functional success of canalicular laceration repairs?Manpreet SinghNatasha GautamNitasha AhirManpreet KaurOriginal ArticleIndian Journal of Ophthalmology 2017 65(11):1114-1119doi:10.4103/ijo.IJO_499_17Indian Journal of Ophthalmology10.4103/ijo.IJO_499_17http://www.ijo.in/text.asp?2017/65/11/1114/218065http://www.ijo.in/text.asp?2017/65/11/1114/218065651111141119http://www.ijo.in/text.asp?2017/65/11/1114/218065Manpreet Singh, Natasha Gautam, Nitasha Ahir, Manpreet Kaur

Indian Journal of Ophthalmology 2017 65(11):1114-1119

Purpose: The aim is to analyze the influence of the location of lacrimal canalicular laceration over the eventual anatomical and functional success after surgery. Methods: Retrospective, observational study of proximal canalicular laceration (PCL) and distal canalicular laceration (DCL) repairs by a single surgeon (MS). The distance between lacrimal punctum and the lateral canalicular lacerated end was defined as proximal (&#60;6 mm) and distal (&#8805;6 mm). The operation theater setup, microscopic magnified view, local adrenaline, and pigtail probe were used to locate the medial canalicular lacerated end. All patients underwent lacrimal stenting and the stents were removed after 3 months (12th week visit). After stent removal, a fluorescein dye disappearance test and lacrimal irrigation were performed to assess the anatomical and functional success of the operation. Results: Of 36 canalicular lacerations, 30 (83.33&#37;) were monocanalicular lacerations which were repaired using monocanalicular stents. Of 6 (16.67&#37;) bicanalicular lacerations, three were repaired using bicanalicular stents while in the remaining three, one monocanalicular stent was placed in each lacerated canaliculi. The medial cut end was identified by magnified visualization in 27 (75&#37;), with adjunctive local adrenaline in four (11.11&#37;) and pigtail probe in five (13.89&#37;) patients. The mean post stent removal follow-up was 44 weeks. The DCL (n &#61; 24, 66.67&#37;) showed better functional and complete success as compared to PCL (75&#37; vs. 33.33&#37;, P &#61; 0.03). Eight (22.22&#37;) had spontaneous stent extrusion, two (5.56&#37;) had loop prolapse, four (11.11&#37;) had punctum granuloma, and three (8.33&#37;) had medial canthus dystopia. Conclusion: The location of canalicular laceration may help to prognosticate the functional and qualified success rate. We experienced better-qualified success in the distal canalicular laceration group.]]>Mon,13 Nov 2017http://www.ijo.in/text.asp?2017/65/11/1114/218065
Diagnosis of limbal stem cell deficiency based on corneal epithelial thickness measured on anterior segment optical coherence tomographyAmit MehtaniMahesh Chandra AgarwalSushant SharmaSantosh ChaudharyOriginal ArticleIndian Journal of Ophthalmology 2017 65(11):1120-1126doi:10.4103/ijo.IJO_218_17Indian Journal of Ophthalmology10.4103/ijo.IJO_218_17http://www.ijo.in/text.asp?2017/65/11/1120/218038http://www.ijo.in/text.asp?2017/65/11/1120/218038651111201126http://www.ijo.in/text.asp?2017/65/11/1120/218038Amit Mehtani, Mahesh Chandra Agarwal, Sushant Sharma, Santosh Chaudhary

Indian Journal of Ophthalmology 2017 65(11):1120-1126

Purpose: The purpose of this study is to investigate the epithelial thickness in the cornea and limbus in limbal stem cell deficiency (LSCD) using anterior segment optical coherence tomography (AS-OCT). Methods: This was a cross-sectional, comparative study. OCT images of 30 eyes of 19 patients with LSCD collected by AS-OCT were scanned. Corneal epithelial thickness was recorded at the central cornea and the superior, nasal, inferior, and temporal limbus. Measurment of the same region of 30 normal eyes served as control. Epithelial thickness in all locations was measured by 2 independent observers. Results: The mean epithelial layer thickness was 61.3 &#177; 2.9 &#956; in the central cornea and 62.7 &#177; 4.3 &#956; in the limbus in the control. The epithelial thickness in LSCD patients was found to be 41.33 &#177; 2.8 &#956;. An average reduction of 22.2&#37; in the central cornea and 32.15&#37; in the limbus was found in patients with LSCD (P &#60; 0.05). Epithelial thinning correlated with the severity of LSCD in both cornea and limbus. In eyes with sectoral LSCD, a similar degree of epithelial thinning was also detected in the clinically unaffected limbal regions. Conclusion: Both corneal and limbal epithelia become progressively thinner in LSCD. Epithelial thickness assessment using AS-OCT as a noninvasive tool could be used as a diagnostic measure of LSCD.]]>Mon,13 Nov 2017http://www.ijo.in/text.asp?2017/65/11/1120/218038
The inhibitory effect of different concentrations of KH902 eye drops on corneal neovascularization induced by alkali burnYan WuChunyan XueYan LuZhenping HuangOriginal ArticleIndian Journal of Ophthalmology 2017 65(11):1127-1132doi:10.4103/ijo.IJO_339_17Indian Journal of Ophthalmology10.4103/ijo.IJO_339_17http://www.ijo.in/text.asp?2017/65/11/1127/218043http://www.ijo.in/text.asp?2017/65/11/1127/218043651111271132http://www.ijo.in/text.asp?2017/65/11/1127/218043Yan Wu, Chunyan Xue, Yan Lu, Zhenping Huang

Indian Journal of Ophthalmology 2017 65(11):1127-1132

Purpose: The aim of this study was to evaluate the inhibitory effect of different concentrations of KH902 eye drops on rabbit corneal neovascularization (CNV) induced by alkali burn. Methods: Forty-eight adult rabbits were randomized into four groups after alkali burning: Group A (2.5 mg/ml), Group B (5 mg/ml), and Group C (10 mg/ml) by different concentrations of KH902 eye drops and Group D by saline solution as control with three times a day for 2 weeks. At days 7, 14, and 28, the anterior segment photographs, confocal microscopy, and histopathology were performed to evaluate corneal opacity, neovascularization, inflammatory cell density, vessel size, and edema. Immunohistochemistry was applied to analyze the vascular endothelial growth factor (VEGF) level. Results: (1) The CNV in the medicine-treated groups showed a reduction without obvious corneal side effects histologically. (2) Compared to the control group, the three medicine-treated groups showed a reduction in the VEGF levels and CNV areas on days 7, 14, and 28 and in the inflammatory cell density on days 14 and 28 (P &#60; 0.01). The difference of inflammatory cell density between the three medicine-treated groups existed on day 14 (P &#60; 0.01). There were differences in the VEGF levels between Groups A, B, and C on days 7, 14, and 28 (P &#60; 0.01), not for Groups B and C on day 28 (P &#62; 0.05). Conclusion: KH902 eye drops in lower concentration showed an obvious reduction of the CNV growing for rabbit corneal alkali burn without side effects.]]>Mon,13 Nov 2017http://www.ijo.in/text.asp?2017/65/11/1127/218043
Comparison of the Endosaver with noninjector techniques in Descemet&#39;s stripping endothelial keratoplastyMichael TsatsosIoannis AthanasiadisNikolaos KopsachilisRadhika KrishnanParwez HossainDavid AndersonOriginal ArticleIndian Journal of Ophthalmology 2017 65(11):1133-1137doi:10.4103/ijo.IJO_360_17Indian Journal of Ophthalmology10.4103/ijo.IJO_360_17http://www.ijo.in/text.asp?2017/65/11/1133/218045http://www.ijo.in/text.asp?2017/65/11/1133/218045651111331137http://www.ijo.in/text.asp?2017/65/11/1133/218045Michael Tsatsos, Ioannis Athanasiadis, Nikolaos Kopsachilis, Radhika Krishnan, Parwez Hossain, David Anderson

Indian Journal of Ophthalmology 2017 65(11):1133-1137

Purpose: Minimal loss of corneal endothelial cells during corneal transplantation is a major target but remains a point of controversy among specialists. Hence, the available method to best achieve this continues to stir progress in the field. The aim of this study is to evaluate the use of the Endosaver injector device for graft insertion in Descemet&#39;s stripping endothelial keratoplasty (DSEK) and compare the visual outcomes and endothelial cell survival between the Endosaver injector and Goosey grasping forceps insertion techniques. Methods: This was a retrospective, interventional, consecutive case series undertaken at the University of Southampton Eye Department to assess outcomes of DSEK using the Endosaver injector device compared to noninjector DSEK insertion. Postoperative specular microscopy alongside manifest refraction at 6 and 12 months was evaluated and compared. Mann&#8211;Whitney U-test was employed for the statistical analysis of data. Results: Both the Endosaver and Goosey forceps groups showed an improvement in best corrected visual acuity. No significant statistical difference was found in preoperative and postoperative best-corrected visual acuity between the Endosaver and non-Endosaver insertion groups. Mean preoperative endothelial cell count was 2660 (&#177;130) for the Endosaver group and 2608 (&#177;66) for the non-Endosaver group. Postoperative endothelial counts at 6 and 12 months showed a significant difference between the Endosaver: 2104 (&#177;199)&#8211;1896 (&#177;226) and the non-Endosaver: 1492 (&#177;207)&#8211;1314 (&#177;224) (P &#60; 0.005) groups, respectively. Conclusion: The Endosaver injection device is associated with less trauma to endothelium during graft insertion due to the minimal touch technique employed. A smaller insertion wound of 4.0 mm compared to noninjector cases enabled a more stable system during surgery with no or minimal anterior chamber shallowing. The combination of a stable host with minimal endothelial graft handling and subsequent trauma potentially leads to higher endothelial cell counts when the Endosaver injection device is used compared to forceps insertion.]]>Mon,13 Nov 2017http://www.ijo.in/text.asp?2017/65/11/1133/218045
Comparison of seropositivity of human immunodeficiency virus, hepatitis B virus, hepatitis C virus, and syphilis among Hospital Cornea Retrieval Programme-Donors versus voluntary cornea donors at a large eye bank in Eastern IndiaSoham BasakSamar K BasakBani BiswasOriginal ArticleIndian Journal of Ophthalmology 2017 65(11):1138-1142doi:10.4103/ijo.IJO_472_17Indian Journal of Ophthalmology10.4103/ijo.IJO_472_17http://www.ijo.in/text.asp?2017/65/11/1138/218057http://www.ijo.in/text.asp?2017/65/11/1138/218057651111381142http://www.ijo.in/text.asp?2017/65/11/1138/218057Soham Basak, Samar K Basak, Bani Biswas

Indian Journal of Ophthalmology 2017 65(11):1138-1142

Purpose: To compare the serology profile of donors from Hospital Cornea Retrieval Programme-donors (HCRP-D) and voluntary cornea donors (VC-D) from a large eye bank in Eastern India. Methods: This is a retrospective analysis of donor details from January 2011 to December 2016. Donor demographics, cause of death, and serology reports were compiled. Postmortem blood was tested for human immunodeficiency virus 1 and 2 (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV), and syphilis using government-approved kits as per the National Programme for Control of Blindness Standards of Eye Banking. Donors for whom serology was not possible were excluded. Results: A total of 4300 of 4353 donors were included of which 74.3&#37; were hospital donors and 25.7&#37; were voluntary donors. A total of 93 (2.2&#37;) donors with 94 seropositive reports were noted: 79 (84.9&#37;) from HCRP-D and 14 (15.1&#37;) from VC-D which was statistically significantly higher (P &#61; 0.02). Among seropositive reports, HIV, HBV, HCV, and syphilis accounted for 12 (12.8&#37;), 38 (40.4&#37;), 36 (38.3&#37;), and eight (8.5&#37;), respectively. There was no correlation between the cause of death and seropositivity. A statistically significant decreasing trend in seroprevalence among hospital donors was observed over the years (5.3&#37; in 2011 to 1.4&#37; in 2016; P &#61; 0.004). Two (0.47&#37;) of 421 hospital donors with prior negative serology were found to be seropositive. Conclusion: Seropositive rates are significantly higher among hospital donors in spite of medical prescreening compared to nonscreened voluntary donors. Serology should be repeated even when prior reports are available.]]>Mon,13 Nov 2017http://www.ijo.in/text.asp?2017/65/11/1138/218057
Evaluation of spectral domain optical coherence tomography parameters in ocular hypertension, preperimetric, and early glaucomaTu&#287;ba AydoganBet&#220;l &#304;lkay Sezgin Ak&#231;ayEsra Karde&#351;Ahmet ErginOriginal ArticleIndian Journal of Ophthalmology 2017 65(11):1143-1150doi:10.4103/ijo.IJO_157_17Indian Journal of Ophthalmology10.4103/ijo.IJO_157_17http://www.ijo.in/text.asp?2017/65/11/1143/218037http://www.ijo.in/text.asp?2017/65/11/1143/218037651111431150http://www.ijo.in/text.asp?2017/65/11/1143/218037Tu&#287;ba Aydogan, Bet&#220;l &#304;lkay Sezgin Ak&#231;ay, Esra Karde&#351;, Ahmet Ergin

Indian Journal of Ophthalmology 2017 65(11):1143-1150

Purpose: The objective of this study is to evaluate the diagnostic ability of retinal nerve fiber layer (RNFL), macular, optic nerve head (ONH) parameters in healthy subjects, ocular hypertension (OHT), preperimetric glaucoma (PPG), and early glaucoma (EG) patients, to reveal factors affecting the diagnostic ability of spectral domain-optical coherence tomography (SD-OCT) parameters and risk factors for glaucoma. Methods: Three hundred and twenty-six eyes (89 healthy, 77 OHT, 94 PPG, and 66 EG eyes) were analyzed. RNFL, macular, and ONH parameters were measured with SD-OCT. The area under the receiver operating characteristic curve (AUC) and sensitivity at 95&#37; specificity was calculated. Logistic regression analysis was used to determine the glaucoma risk factors. Receiver operating characteristic regression analysis was used to evaluate the influence of covariates on the diagnostic ability of parameters. Results: In PPG patients, parameters that had the largest AUC value were average RNFL thickness (0.83) and rim volume (0.83). In EG patients, parameter that had the largest AUC value was average RNFL thickness (0.98). The logistic regression analysis showed average RNFL thickness was a risk factor for both PPG and EG. Diagnostic ability of average RNFL and average ganglion cell complex thickness increased as disease severity increased. Signal strength index did not affect diagnostic abilities. Diagnostic ability of average RNFL and rim area increased as disc area increased. Conclusion: When evaluating patients with glaucoma, patients at risk for glaucoma, and healthy controls RNFL parameters deserve more attention in clinical practice. Further studies are needed to fully understand the influence of covariates on the diagnostic ability of OCT parameters.]]>Mon,13 Nov 2017http://www.ijo.in/text.asp?2017/65/11/1143/218037
Simultaneous use of amniotic membrane and Mitomycin C in trabeculectomy for primary glaucomaUsha YadavaKirti JaisinghSonal DangdaProlima ThackerKirti SinghYashpal GoelOriginal ArticleIndian Journal of Ophthalmology 2017 65(11):1151-1155doi:10.4103/ijo.IJO_447_17Indian Journal of Ophthalmology10.4103/ijo.IJO_447_17http://www.ijo.in/text.asp?2017/65/11/1151/218056http://www.ijo.in/text.asp?2017/65/11/1151/218056651111511155http://www.ijo.in/text.asp?2017/65/11/1151/218056Usha Yadava, Kirti Jaisingh, Sonal Dangda, Prolima Thacker, Kirti Singh, Yashpal Goel

Indian Journal of Ophthalmology 2017 65(11):1151-1155

Purpose: This study aimed to propose the role of amniotic membrane transplantation (AMT) as an additional modulator in primary Mitomycin C (MMC)-augmented trabeculectomy. Methods: This was a randomized prospective interventional study. Forty eyes of 39 adult patients with uncontrolled primary glaucoma were randomly divided into two equal groups. Control group underwent trabeculectomy augmented with MMC while the study group underwent additional AMT. Patients were followed up for 12 months and outcomes measured were intraocular pressure (IOP), need for additional intervention, and bleb morphology. Results: Complete success (defined as IOP &#60;16 mmHg on no medication) could be achieved in 85&#37; eyes in study group while it was 60&#37; in control group (P &#61; 0.04). IOP reduced by 71.1&#37; in study group from 41.9 &#177; 10.6 to 12.1 &#177; 2.7 mmHg and from 40.5 &#177; 8.5 to 12.8 &#177; 4.5 mmHg in control group, a decline of 68.29&#37;. Blebs in AMT group showed better bleb morphology in terms of significantly better extent (E3) on day 1 (P &#61; 0.03) and better height (H2 and H3) (P &#61; 0.04), according to the Indiana Bleb Appearance Grading Scale, at all follow-up visits along with normal vascularity. The study group required significantly lesser (P &#61; 0.03) bleb needlings as compared to control group. Conclusion: Amnion enhanced the efficacy of MMC-modulated trabeculectomy in terms of eyes with complete success and lesser interventions such as bleb needling. This reiterates the role of amnion as a safe and effective bleb modulator. A diffusely elevated bleb with healthier conjunctiva can go a long way in predicting better health and longevity of the bleb.]]>Mon,13 Nov 2017http://www.ijo.in/text.asp?2017/65/11/1151/218056
Frequency of primary mutations of Leber&#39;s hereditary optic neuropathy patients in North Indian populationAnushree MishraSaranya DeviRohit SaxenaNeerja GuptaMadhulika KabraMadhumita Roy ChowdhuryOriginal ArticleIndian Journal of Ophthalmology 2017 65(11):1156-1160doi:10.4103/ijo.IJO_380_17Indian Journal of Ophthalmology10.4103/ijo.IJO_380_17http://www.ijo.in/text.asp?2017/65/11/1156/218047http://www.ijo.in/text.asp?2017/65/11/1156/218047651111561160http://www.ijo.in/text.asp?2017/65/11/1156/218047Anushree Mishra, Saranya Devi, Rohit Saxena, Neerja Gupta, Madhulika Kabra, Madhumita Roy Chowdhury

Indian Journal of Ophthalmology 2017 65(11):1156-1160

Purpose: Leber&#39;s hereditary optic neuropathy (LHON) is an inherited optic neuropathy characterized by subacute painless vision loss. The majority of LHON is caused due to one of the three primary mutations in the mitochondrial DNA (m.G3460A, m.G11778A, and m.T14484C). The frequency of these mutations differs in different populations. The purpose of this study is to observe the frequency of three common primary mutations in the North Indian population. Methods: Forty LHON patients within the age group of 10&#8211;50 years underwent molecular testing for primary mutations. For two patients, testing for mother and other siblings was also carried out, using bidirectional sequencing. Results: A total of 11 out of 40 (27.5&#37;) patients were found to be carrying m.G11778A mutation. Siblings of two probands were also positive for the same mutation. In one family, two primary mutations (m.G11778A and m.T14484C) were found in the proband and in the mother as well. Conclusion: In this study, 27.5&#37; mutation was detected in North Indian LHON families. These results suggest that m.G11778A mutation is more frequent in this population. The results of the present study are compatible with studies of an Asian population and Northern European population.]]>Mon,13 Nov 2017http://www.ijo.in/text.asp?2017/65/11/1156/218047
Next-generation sequencing reveals a novel NDP gene mutation in a Chinese family with Norrie diseaseXiaoyan HuangMao TianJiankang LiLing CuiMin LiJianguo ZhangOriginal ArticleIndian Journal of Ophthalmology 2017 65(11):1161-1165doi:10.4103/ijo.IJO_442_17Indian Journal of Ophthalmology10.4103/ijo.IJO_442_17http://www.ijo.in/text.asp?2017/65/11/1161/218055http://www.ijo.in/text.asp?2017/65/11/1161/218055651111611165http://www.ijo.in/text.asp?2017/65/11/1161/218055Xiaoyan Huang, Mao Tian, Jiankang Li, Ling Cui, Min Li, Jianguo Zhang

Indian Journal of Ophthalmology 2017 65(11):1161-1165

Purpose: Norrie disease (ND) is a rare X-linked genetic disorder, the main symptoms of which are congenital blindness and white pupils. It has been reported that ND is caused by mutations in the NDP gene. Although many mutations in NDP have been reported, the genetic cause for many patients remains unknown. In this study, the aim is to investigate the genetic defect in a five-generation family with typical symptoms of ND. Methods: To identify the causative gene, next-generation sequencing based target capture sequencing was performed. Segregation analysis of the candidate variant was performed in additional family members using Sanger sequencing. Results: We identified a novel missense variant (c.314C>A) located within the NDP gene. The mutation cosegregated within all affected individuals in the family and was not found in unaffected members. By happenstance, in this family, we also detected a known pathogenic variant of retinitis pigmentosa in a healthy individual. Conclusion: c.314C>A mutation of NDP gene is a novel mutation and broadens the genetic spectrum of ND.]]>Mon,13 Nov 2017http://www.ijo.in/text.asp?2017/65/11/1161/218055
Stenotrophomonas maltophilia: An emerging entity for cluster endophthalmitisSarita BeriAnurag ShandilRajiv GargOriginal ArticleIndian Journal of Ophthalmology 2017 65(11):1166-1171doi:10.4103/ijo.IJO_314_17Indian Journal of Ophthalmology10.4103/ijo.IJO_314_17http://www.ijo.in/text.asp?2017/65/11/1166/218040http://www.ijo.in/text.asp?2017/65/11/1166/218040651111661171http://www.ijo.in/text.asp?2017/65/11/1166/218040Sarita Beri, Anurag Shandil, Rajiv Garg

Indian Journal of Ophthalmology 2017 65(11):1166-1171

Purpose: This was a study of acute cluster endophthalmitis along with clinical features, culture results, and visual outcomes of 10 eyes of 10 patients after intravitreal injection of Avastin (bevacizumab) in one sitting from a single vial. Methods: Retrospective review of intravitreal injection of 1.25 mg/0.05 ml bevacizumab that was given to 10 eyes of 10 patients on the same day from a freshly opened vial. All patients manifested with endophthalmitis the next day. Vitreous tap for direct smear and culture was done. Intravitreal antibiotics and steroids were injected and appropriate treatment begun. The injection vial of the same batch was sent for VITEKTM identification and antimicrobial susceptibility of isolates. Results: Endophthalmitis presented within 24 h of intravitreal injection. There was a remarkable absence of posterior pupillary synechia. Two cases were culture-positive (20&#37;), showing pseudomonoid growth. The vial of the same batch revealed a pseudomonoid bacilli Stenotrophomonas maltophilia using VITEKTM, which was resistant to multiple drugs. Hence, the contaminated vial was identified as the source of infection in our case. Among 10 patients, two underwent pars plana vitrectomy. Visual acuity returned to preendophthalmitis levels in 9/10 eyes after 1 month. One patient was lost to follow-up. Late complications included retinal detachment in one case and neovascular glaucoma in another. Conclusion: Early recognition and treatment are key factors in improving outcomes. Causative etiology could be microbial contamination of the drug vial. S. maltophilia should be considered a pathogenic organism of postintravitreal endophthalmitis.]]>Mon,13 Nov 2017http://www.ijo.in/text.asp?2017/65/11/1166/218040
Retinal shortening: Ultrasonic evaluation of proliferative vitreoretinopathyBrijesh TakkarShreyas TemkarNripen GaurPradeep VenkateshRohan ChawlaAtul KumarOriginal ArticleIndian Journal of Ophthalmology 2017 65(11):1172-1177doi:10.4103/ijo.IJO_481_17Indian Journal of Ophthalmology10.4103/ijo.IJO_481_17http://www.ijo.in/text.asp?2017/65/11/1172/218061http://www.ijo.in/text.asp?2017/65/11/1172/218061651111721177http://www.ijo.in/text.asp?2017/65/11/1172/218061Brijesh Takkar, Shreyas Temkar, Nripen Gaur, Pradeep Venkatesh, Rohan Chawla, Atul Kumar

Indian Journal of Ophthalmology 2017 65(11):1172-1177

Purpose: To evaluate the effect of extraretinal proliferative vitreoretinopathy (PVR) on retinal shortening in eyes with rhegmatogenous retinal detachment (RD) using ultrasound (USG) and objectively prove the presence of intraretinal PVR (iPVR). Methods: This is a double-masked pilot prospective controlled case series. Patients with total RD planned for vitreoretinal surgery were included in the study. USG was used to determine retinal-to-choroidal length ratios (RCRs) in all the quadrants. Group 1 included 10 patients with preoperative PVR more than Grade B while Group 2 had 14 with PVR of Grades A or B. Severe retinal shortening was defined as RCR &#60; 0.8. Primary outcome measures were severe retinal shortening and an early unexplained recurrence of RD within 15 days of surgery. Results: Mean RCRs were significantly low in all the four quadrants of Group 1 upon comparison with Group 2. The mean RCR had a good negative correlation with number of quadrants of PVR (R &#61; &#8722;0.66, P &#8804; 0.001). Overall, severe quadrantic retinal shortening was detected in nine patients. In these 9 patients, 11 of the 36 retinal quadrants had severe retinal shortening in the absence of extraretinal PVR (ePVR). Six patients developed early unexplained RD, and all of these belonged to Group 1. Severe quadrantic retinal shortening had the highest odds ratio of developing early unexplained RD (odds ratio &#61; 58, P &#61; 0.01). Conclusion: Retinal shortening occurs both due to ePVR and iPVR, and iPVR occurs independently at least in some cases. Severe quadrantic retinal shortening indicates poor primary anatomical prognoses.]]>Mon,13 Nov 2017http://www.ijo.in/text.asp?2017/65/11/1172/218061
Efficacy of 1&#37; atropine eye drops in retarding progressive axial myopia in Indian eyesMihir KothariVivek RathodOriginal ArticleIndian Journal of Ophthalmology 2017 65(11):1178-1181doi:10.4103/ijo.IJO_418_17Indian Journal of Ophthalmology10.4103/ijo.IJO_418_17http://www.ijo.in/text.asp?2017/65/11/1178/218053http://www.ijo.in/text.asp?2017/65/11/1178/218053651111781181http://www.ijo.in/text.asp?2017/65/11/1178/218053Mihir Kothari, Vivek Rathod

Indian Journal of Ophthalmology 2017 65(11):1178-1181

Purpose: The aim of this study is to assess the efficacy of 1&#37; atropine eye drops for the retardation of progressive axial myopia in Indian eyes. Methods: This prospective interventional cohort study included children aged 5&#8211;16 years. Both the eyes of myopic children with progressive increase of &#8805;&#8722;0.5D sphere/year with the best-corrected vision of &#8805;6/6 were treated with once a day application of 1&#37; atropine eye drops and progressive addition photogray lenses. The progression of myopia after 1-year follow-up was analyzed. Results: Sixty eyes of thirty myopes were included in the study. The mean age was 10 years and 15 were girls. The mean baseline sphere was &#8722;5.2D (&#8722;2.5D&#8211;&#8722;13D). Mean duration of follow-up was 23 months (12&#8211;36 months). The baseline rate of progression was reduced from &#8722;0.6D/year (range &#8722;0.5D/year to &#8722;3D/year) to &#8722;0.2D/year (range 0D/year to &#8722;1.5D/year) after atropine therapy. Seventeen patients (57&#37;) had to use the atropine in the daytime to reach the target progression of Mon,13 Nov 2017http://www.ijo.in/text.asp?2017/65/11/1178/218053
Conquering myopia: Have we hit pay dirt?Siddharth S KesarwaniCommentaryIndian Journal of Ophthalmology 2017 65(11):1182-1182doi:10.4103/ijo.IJO_951_17Indian Journal of Ophthalmology10.4103/ijo.IJO_951_17http://www.ijo.in/text.asp?2017/65/11/1182/218086http://www.ijo.in/text.asp?2017/65/11/1182/218086651111821182http://www.ijo.in/text.asp?2017/65/11/1182/218086Siddharth S Kesarwani

Purpose: This study aims to describe and compare modified hang-back recession with the conventional hang-back recession in large angle comitant exotropia (XT). Methods: A prospective, interventional, double-blinded, randomized study on adult patients (&#62;18 years) undergoing single eye recession-resection for large angle (&#62;30 prism diopters) constant comitant XT was conducted between January 2011 and December 2015. Patients in Group A underwent modified hang-back lateral rectus recession with adjustable knot while in Group B underwent conventional hang-back recession with an adjustable knot. Outcome parameters studied were readjustment rate, change in deviation at 6 weeks, complications and need for resurgery at 6 months. Results: The groups were comparable in terms of age and preoperative deviation. The patients with the modified hang back (Group A) fared significantly better (P &#60; 0.05) than those with conventional hang back (Group B) in terms of lesser need for adjustment, greater correction in deviation at 6 weeks and lesser need for resurgery at 6 months. Conclusion: This modification offers several advantages, significantly reduces resurgery requirement and has no added complications.]]>Mon,13 Nov 2017http://www.ijo.in/text.asp?2017/65/11/1183/218042
Is pediatric ophthalmology a popular subspecialty in India: Present scenario and future remediesSucheta ParijaPreetam MahajanOriginal ArticleIndian Journal of Ophthalmology 2017 65(11):1187-1191doi:10.4103/ijo.IJO_548_17Indian Journal of Ophthalmology10.4103/ijo.IJO_548_17http://www.ijo.in/text.asp?2017/65/11/1187/218074http://www.ijo.in/text.asp?2017/65/11/1187/218074651111871191http://www.ijo.in/text.asp?2017/65/11/1187/218074Sucheta Parija, Preetam Mahajan

Indian Journal of Ophthalmology 2017 65(11):1187-1191

Purpose: The aim of the study was to assess the attitude and perceptions of residents regarding Pediatric Ophthalmology and Strabismus (POS) subspecialty training. We also explored the possible barriers and solutions to promoting POS in India. Methods: A questionnaire consisting of 20 items, with a 5-point Likert scale, was provided to all postgraduate residents of Ophthalmology in the year 2013&#8211;2014. Semistructured interview of a selected panel of experts was carried out to understand the challenges, barriers, and opportunities for developing POS subspecialty in India. The data collected were coded and statistically analyzed using standard methods for quantitative and qualitative data. Results: Out of 81 residents, 69 responded (85.2&#37;). The mean age of the respondents was 27.5 &#177; 1.23 years. Forty eight (69.0&#37;) residents reported that there was no structured surgical teaching and systematic periodic posting in this subspecialty during their residency program. Residents who stated difficulty to understand the subject were 59&#37;. Pursuing POS as a career choice was indicated by 21.0&#37;. Major attracting attributes of POS fellowship were intellectual stimulation (69.7&#37;) and independent operative skills (57.5&#37;). Dissuading factors were difficulty to handle children (54.5&#37;) and stress factor (48.4&#37;). Expert views were grouped under four domains, such as doctor&#8211;patient ratio, infrastructure, training opportunities, utilization, and accessibility to POS services. Conclusion: The study has provided useful insights into the preferential behavior among trainee resident doctors and reasons for not choosing POS as a possible choice of future fellowships.]]>Mon,13 Nov 2017http://www.ijo.in/text.asp?2017/65/11/1187/218074
Epidemiology, clinical profile and factors, predicting final visual outcome of pediatric ocular trauma in a tertiary eye care center of Central IndiaSatendra SinghBhavana SharmaKavita KumarAditi DubeyKanchan AhirwarOriginal ArticleIndian Journal of Ophthalmology 2017 65(11):1192-1197doi:10.4103/ijo.IJO_375_17Indian Journal of Ophthalmology10.4103/ijo.IJO_375_17http://www.ijo.in/text.asp?2017/65/11/1192/218046http://www.ijo.in/text.asp?2017/65/11/1192/218046651111921197http://www.ijo.in/text.asp?2017/65/11/1192/218046Satendra Singh, Bhavana Sharma, Kavita Kumar, Aditi Dubey, Kanchan Ahirwar

Indian Journal of Ophthalmology 2017 65(11):1192-1197

Purpose: Ocular trauma constitutes an important cause of preventable visual morbidity worldwide. This study was done to study the incidence, sociodemographic pattern, and clinical profile of ocular trauma in pediatric age group. Also to evaluate the factors influencing final visual outcome in these patients. Methods: This was a prospective interventional study concerning ocular trauma in pediatric patients up to 16 years of age of either sex. Various variables having an impact on final visual outcome were studied, and results were analyzed using statistical indices &#8211; relative risk, Chi-square test, P value, and linear regression analysis. Results: A total of 220 cases of trauma were evaluated with the mean age being 8.74 &#177; 3.93 years, males were predominantly affected and open globe injuries outnumbered blunt injuries. Penetrating injuries accounted for 67.79&#37; cases of open globe injury, rupture being the least (2.54&#37;). Stepwise multiple linear regression analysis executed, showed the best predictors in the descending order for final visual outcome were presenting visual acuity, size of corneal tear, type of injury, zone of injury, time period between injury and treatment with a variance of 35.9&#37;, 6.3&#37;, 5.3&#37;, 3.7&#37;, and 2.7&#37;, respectively. All above variables were also found to be statistically significant (P &#60; 0.05) on Chi-square test. Conclusion: We report the first study on the epidemiology and clinical outcomes of pediatric ocular trauma in central India. Poor initial Visual Acuity and posterior segment involvement adversely affect the visual outcome. Early medical treatment and globe-salvaging repair should be done in all eyes suffering from trauma.]]>Mon,13 Nov 2017http://www.ijo.in/text.asp?2017/65/11/1192/218046
Comparison of 30-2 Standard and Fast programs of Swedish Interactive Threshold Algorithm of Humphrey Field Analyzer for perimetry in patients with intracranial tumorsManav Deep SinghKanika JainOriginal ArticleIndian Journal of Ophthalmology 2017 65(11):1198-1202doi:10.4103/ijo.IJO_315_17Indian Journal of Ophthalmology10.4103/ijo.IJO_315_17http://www.ijo.in/text.asp?2017/65/11/1198/218041http://www.ijo.in/text.asp?2017/65/11/1198/218041651111981202http://www.ijo.in/text.asp?2017/65/11/1198/218041Manav Deep Singh, Kanika Jain

Indian Journal of Ophthalmology 2017 65(11):1198-1202

Purpose: To find out whether 30-2 Swedish Interactive Threshold Algorithm (SITA) Fast is comparable to 30-2 SITA Standard as a tool for perimetry among the patients with intracranial tumors. Methods: This was a prospective cross-sectional study involving 80 patients aged &#8805;18 years with imaging proven intracranial tumors and visual acuity better than 20/60. The patients underwent multiple visual field examinations using the two algorithms till consistent and repeatable results were obtained. Results: A total of 140 eyes of 80 patients were analyzed. Almost 60&#37; of patients undergoing perimetry with SITA Standard required two or more sessions to obtain consistent results, whereas the same could be obtained in 81.42&#37; with SITA Fast in the first session itself. Of 140 eyes, 70 eyes had recordable field defects and the rest had no defects as detected by either of the two algorithms. Mean deviation (MD) (P &#61; 0.56), pattern standard deviation (PSD) (P &#61; 0.22), visual field index (P &#61; 0.83) and number of depressed points at P &#60; 5&#37;, 2&#37;, 1&#37;, and 0.5&#37; on MD and PSD probability plots showed no statistically significant difference between two algorithms. Bland&#8211;Altman test showed that considerable variability existed between two algorithms. Conclusion: Perimetry performed by SITA Standard and SITA Fast algorithm of Humphrey Field Analyzer gives comparable results among the patients of intracranial tumors. Being more time efficient and with a shorter learning curve, SITA Fast my be recommended as a standard test for the purpose of perimetry among these patients.]]>Mon,13 Nov 2017http://www.ijo.in/text.asp?2017/65/11/1198/218041
Hospital anxiety and depression scale assessment of 100 patients before and after using low vision care: A prospective study in a tertiary eye-care settingPukhraj RishiEkta RishiAditya MaitrayAshutosh AgarwalSridevi NairSarika GopalakrishnanOriginal ArticleIndian Journal of Ophthalmology 2017 65(11):1203-1208doi:10.4103/ijo.IJO_436_17Indian Journal of Ophthalmology10.4103/ijo.IJO_436_17http://www.ijo.in/text.asp?2017/65/11/1203/218054http://www.ijo.in/text.asp?2017/65/11/1203/218054651112031208http://www.ijo.in/text.asp?2017/65/11/1203/218054Pukhraj Rishi, Ekta Rishi, Aditya Maitray, Ashutosh Agarwal, Sridevi Nair, Sarika Gopalakrishnan

A 20-year-old girl presented with a large pigmented lesion over the temporal aspect of left lateral canthus involving the lateral one-third of both eyelids, since birth. A slow increase in its size had been noticed for the past 2 years. On examination, a hairy nevus measuring 34 mm &#215; 22 mm was noticed involving left eyelid skin, the mucocutaneous junction (MCJ), palpebral conjunctiva, and lateral canthus. The surface was irregularly thick and covered with long, thick, and pigmented hairs. A clinical diagnosis of kissing nevus of eyelids was kept and a surgical resection with reconstruction planned. A customized full-thickness skin graft (FTSG) and amniotic membrane grafts (AMGs) were used for the reconstruction of cutaneous and MCJ, respectively. Histopathology showed the features of junctional nevus. At 4 months of follow-up, a well taken FTSG and healthy/sharp MCJ were noticed with no recurrence. We advocate a possible role of AMG, particularly in the reconstruction of the conjunctival mucosa and MCJ.]]>Mon,13 Nov 2017http://www.ijo.in/text.asp?2017/65/11/1219/218050
Congenital capillary hemangioma arising from palpebral conjunctiva of a neonateS PadmanabanP SumathiPrayagi KandothRP DharmendraBrief CommunicationIndian Journal of Ophthalmology 2017 65(11):1221-1223doi:10.4103/ijo.IJO_487_17Indian Journal of Ophthalmology10.4103/ijo.IJO_487_17http://www.ijo.in/text.asp?2017/65/11/1221/218063http://www.ijo.in/text.asp?2017/65/11/1221/218063651112211223http://www.ijo.in/text.asp?2017/65/11/1221/218063S Padmanaban, P Sumathi, Prayagi Kandoth, RP Dharmendra

Indian Journal of Ophthalmology 2017 65(11):1221-1223

Capillary hemangioma is the most common benign vascular eyelid tumor in childhood. The periocular lesion appears within the first few weeks after birth and usually has superficial or deep components. Primary conjunctival capillary hemangiomas are rarely reported. We present the case of a 2-day-old child with a pedunculated capillary hemangioma arising from superior palpebral conjunctiva. A complete surgical excision was performed under general anesthesia, and the child was asymptomatic at follow-up of two months.]]>Mon,13 Nov 2017http://www.ijo.in/text.asp?2017/65/11/1221/218063
Predescemetocele: A distinct clinical entityPriya NarangAmar AgarwalDhivya Ashok KumarBrief CommunicationIndian Journal of Ophthalmology 2017 65(11):1224-1226doi:10.4103/ijo.IJO_492_17Indian Journal of Ophthalmology10.4103/ijo.IJO_492_17http://www.ijo.in/text.asp?2017/65/11/1224/218064http://www.ijo.in/text.asp?2017/65/11/1224/218064651112241226http://www.ijo.in/text.asp?2017/65/11/1224/218064Priya Narang, Amar Agarwal, Dhivya Ashok Kumar

Indian Journal of Ophthalmology 2017 65(11):1224-1226

The case report incorporates a Fourier-domain optical coherence tomography (OCT) examination for demonstration of the existence of pre-Descemet&#39;s layer (PDL; Dua&#39;s layer) overlying a descemetocele and demonstrates predescemetocele as a separate clinical entity. The prospective analysis was done in two cases that had descemetocele, and OCT demonstrated the presence of PDL over an unruptured descemetocele that offers resilience and can be treated with an elective deep anterior lamellar keratoplasty or a penetrating keratoplasty. A descemetocele, when covered with PDL, should be correctly designated as a predescemetocele. Loss of PDL leads to baring of Descemet&#39;s membrane that eventually ruptures.]]>Mon,13 Nov 2017http://www.ijo.in/text.asp?2017/65/11/1224/218064
The sting of a honey bee: An unusual subconjunctival foreign bodySushank A BhaleraoPrabhakar SinghPadmaja Kumari RaniVarsha RathiBrief CommunicationIndian Journal of Ophthalmology 2017 65(11):1226-1228doi:10.4103/ijo.IJO_533_17Indian Journal of Ophthalmology10.4103/ijo.IJO_533_17http://www.ijo.in/text.asp?2017/65/11/1226/218069http://www.ijo.in/text.asp?2017/65/11/1226/218069651112261228http://www.ijo.in/text.asp?2017/65/11/1226/218069Sushank A Bhalerao, Prabhakar Singh, Padmaja Kumari Rani, Varsha Rathi

Indian Journal of Ophthalmology 2017 65(11):1226-1228

Ocular foreign bodies (FBs) are often encountered in clinical practices. However, there are cases in which the presence of the FB is difficult to diagnose based on mere history taking and/or clinical examination. We herein present a case of unusual subconjunctival foreign body in the form of the sting of a honey bee in a 63-year-old farmer. This was removed from the superior forniceal subconjunctival space in toto with forceps under a microscope in the operation theater. This case emphasizes the need to elicit a complete history and a careful ocular examination with double eversion of the eyelid to avoid missing any foreign body lodged in the fornices and subconjunctival space in patients who complained of foreign body sensation.]]>Mon,13 Nov 2017http://www.ijo.in/text.asp?2017/65/11/1226/218069
A tiny tick can cause a big health problemManuel JohnM RamanKeith RyanBrief CommunicationIndian Journal of Ophthalmology 2017 65(11):1228-1232doi:10.4103/ijo.IJO_411_17Indian Journal of Ophthalmology10.4103/ijo.IJO_411_17http://www.ijo.in/text.asp?2017/65/11/1228/218051http://www.ijo.in/text.asp?2017/65/11/1228/218051651112281232http://www.ijo.in/text.asp?2017/65/11/1228/218051Manuel John, M Raman, Keith Ryan

Indian Journal of Ophthalmology 2017 65(11):1228-1232

Ticks are tiny crawling bugs in the spider family that feed by sucking blood from animals. They are second only to mosquitoes as vectors of human disease, both infectious and toxic. Infected ticks spread over a hundred diseases, some of which are fatal if undetected. They spread the spirochete (which multiplies in the insect&#39;s gut) with a subsequent bite to the next host. We describe the only reported cases of peri ocular tick bite from India that presented to us within a span of 3 days and its management. Due suspicion and magnification of the lesions revealed the ticks which otherwise masqueraded as small skin tags/moles on gross examination. The ticks were firmly latched on to the skin and careful removal prevented incarceration of the mouth parts. Rickettsial diseases that were believed to have disappeared from India are reemerging and their presence has recently been documented in at least 11 states in the country. Among vector borne diseases, the most common, Lyme disease, also known as the great mimicker, can present with rheumatoid arthritis, fibromyalgia, depression, attention deficit hyperactivity disorder, multiple sclerosis, chronic fatigue syndrome, cardiac manifestations, encephalitis, and mental illness, to name some of the many associations. Common ocular symptoms and signs include conjunctivitis, keratitis, uveitis, and retinitis. Early detection and treatment of tick borne diseases is important to prevent multi system complications that can develop later in life.]]>Mon,13 Nov 2017http://www.ijo.in/text.asp?2017/65/11/1228/218051
Combined central retinal artery and vein occlusion with optic perineuritis following herpes zoster dermatitis in an immunocompetent childReema BansalRamandeep SinghAastha TakkarVivek LalBrief CommunicationIndian Journal of Ophthalmology 2017 65(11):1233-1235doi:10.4103/ijo.IJO_480_17Indian Journal of Ophthalmology10.4103/ijo.IJO_480_17http://www.ijo.in/text.asp?2017/65/11/1233/218060http://www.ijo.in/text.asp?2017/65/11/1233/218060651112331235http://www.ijo.in/text.asp?2017/65/11/1233/218060Reema Bansal, Ramandeep Singh, Aastha Takkar, Vivek Lal

This report demonstrates the blood flow pattern in a case of choroidal hemangioma (CH) using swept-source-optical coherence tomography angiography (SS-OCTA). Fluorescein angiography, SS-OCT, and SS-OCTA images of a patient with CH were obtained using a standard protocol. The internal vascular pattern of the tumor was identified on both OCT and OCTA. Dark areas were identified in the CH. These were interspersed between areas of visible blood flow, as imaged on SS-OCTA. Peripheral vascular arcades were also identified within the tumor. SS-OCTA should be evaluated as an imaging tool to study the blood flow within choroidal tumors.]]>Mon,13 Nov 2017http://www.ijo.in/text.asp?2017/65/11/1240/218066
Methoxsalen-induced macular toxicityAditya MaitrayPukhraj RishiBrief CommunicationIndian Journal of Ophthalmology 2017 65(11):1243-1245doi:10.4103/ijo.IJO_413_17Indian Journal of Ophthalmology10.4103/ijo.IJO_413_17http://www.ijo.in/text.asp?2017/65/11/1243/218052http://www.ijo.in/text.asp?2017/65/11/1243/218052651112431245http://www.ijo.in/text.asp?2017/65/11/1243/218052Aditya Maitray, Pukhraj Rishi

Indian Journal of Ophthalmology 2017 65(11):1243-1245

Psoralen compounds such as methoxsalen are photosensitizer agents used in conjunction with ultraviolet A (UVA) radiation exposure as photochemotherapy (Psoralens and ultraviolet-A therapy [PUVA therapy]) for certain epidermal skin disorders such as psoriasis and vitiligo. Methoxsalen has been shown to be associated with premature cataract formation by forming adducts with lens proteins following oral administration and subsequent UVA exposure. Hence, the use of UV-filtering glasses is recommended during PUVA therapy sessions. Ocular tissues can be exposed to its photosensitizing effect with subsequent UV radiation exposure through sunlight if the patient was to be without protective eye glasses, potentially causing macular toxicity. Till date, there have been no reports in the literature of any posterior segment ocular toxicity arising from methoxsalen use. Here, we describe a case of a bilateral macular toxicity in a middle-aged male treated with methoxsalen for vitiligo.]]>Mon,13 Nov 2017http://www.ijo.in/text.asp?2017/65/11/1243/218052
Vitrectomy for full-thickness macular hole in adult-onset Coats&#39; diseaseVinod KumarPradeep KumarGaurav GargSaurabh DamodaranBrief CommunicationIndian Journal of Ophthalmology 2017 65(11):1246-1248doi:10.4103/ijo.IJO_546_17Indian Journal of Ophthalmology10.4103/ijo.IJO_546_17http://www.ijo.in/text.asp?2017/65/11/1246/218073http://www.ijo.in/text.asp?2017/65/11/1246/218073651112461248http://www.ijo.in/text.asp?2017/65/11/1246/218073Vinod Kumar, Pradeep Kumar, Gaurav Garg, Saurabh Damodaran

Indian Journal of Ophthalmology 2017 65(11):1246-1248

The occurrence of full thickness macular hole in Coats&#39; disease is extremely rare. The purpose of this case report is to report pars plana vitrectomy for the treatment of full thickness macular hole in a patient with adult onset Coats disease. A young male presented with decreased vision in his right eye because of full thickness macular hole. The macular hole was found to be associated with adult onset Coats&#39; disease that was evident on ultra-wide field imaging. The patient underwent laser photocoagulation to the vascular telangiectasia followed by pars plana vitrectomy, large internal limiting membrane peeling and gas tamponade. This resulted in regression of exudation, closure of macular hole and improvement in vision. Coats disease of adult onset can present with decreased vision because of full thickness macular hole. Vitrectomy with internal limiting membrane peeling can result in excellent visual outcome.]]>Mon,13 Nov 2017http://www.ijo.in/text.asp?2017/65/11/1246/218073
Severe Gemella haemolysans endophthalmitis following ranibizumab intravitreal injectionSilvia Olivia SalceanuSarah LevyRichard CunninghamKwabena Frimpong-AnsahBrief CommunicationIndian Journal of Ophthalmology 2017 65(11):1249-1251doi:10.4103/ijo.IJO_1007_16Indian Journal of Ophthalmology10.4103/ijo.IJO_1007_16http://www.ijo.in/text.asp?2017/65/11/1249/218034http://www.ijo.in/text.asp?2017/65/11/1249/218034651112491251http://www.ijo.in/text.asp?2017/65/11/1249/218034Silvia Olivia Salceanu, Sarah Levy, Richard Cunningham, Kwabena Frimpong-Ansah

A 12-year-old boy presented with best-corrected visual acuity (BCVA) of 6/9 in both eyes following an episode of electric shock. Optical coherence tomography (OCT) showed disruption of the ellipsoid zone as well as retinal pigment epithelium (RPE) layer. Fundus autofluorescence (FAF) showed increased central hypoautofluorescence in both eyes. At 3-month follow-up, BCVA improved to 6/6 with OCT showing spontaneous resolution of maculopathy in both eyes with reorganized RPE layer and ellipsoid zone. To the best of our knowledge, this is the first case of bilateral electric shock maculopathy (ESM) with spontaneous anatomical as well as functional recovery. Ophthalmologists must be aware of various forms of ESM. OCT and FAF must be done in patients presenting with defective vision and history of electric shock for the diagnostic as well as prognostic evaluation.]]>Mon,13 Nov 2017http://www.ijo.in/text.asp?2017/65/11/1256/218070
Case of intraocular foreign body partly lodged in the ethmoid sinusManish NagpalHardik JainRakesh JunejaShishir Shekhar SinghBrief CommunicationIndian Journal of Ophthalmology 2017 65(11):1262-1263doi:10.4103/ijo.IJO_404_17Indian Journal of Ophthalmology10.4103/ijo.IJO_404_17http://www.ijo.in/text.asp?2017/65/11/1262/218049http://www.ijo.in/text.asp?2017/65/11/1262/218049651112621263http://www.ijo.in/text.asp?2017/65/11/1262/218049Manish Nagpal, Hardik Jain, Rakesh Juneja, Shishir Shekhar Singh